Otitis Media

Otitis media is an inflammation of the middle ear. There are two types of otitis media. Acute otitis media is an ear infection that can cause ear pain, fever, or an inflamed eardrum. Otitis media with effusion is fluid in the middle ear.
Otitis media occurs most often in children under 3 years of age. It is usually a complication of an upper respiratory infection, such as a cold.
Acute otitis media is treated with oral antibiotics. Otitis media with effusion usually goes away on its own without antibiotics.
Preventing otitis media means preventing the upper respiratory infections that can cause it: 1) cover coughs and blow noses with disposable tissues, 2) use good handwashing practices, 3) wash and disinfect toys that children put into their mouths.

What is otitis media?

Otitis media is an inflammation of the middle ear (the air-filled space located behind the eardrum). There are two types of otitis media. acute otitis media is a painful infection of the middle ear. otitis media with effusion is fluid in the middle ear.

What causes otitis media?

Acute otitis media is usually a complication of a cold, sore throat, or other infection of the upper respiratory tract. The eustachian tube connects the ear to the back of the throat. When a child has a stuffy nose, the tube gets blocked. Bacteria (or viruses) become trapped in the middle ear and cause an infection. Fluid and pressure build up behind the eardrum, causing ear pain, swelling, and redness. Bacteria are responsible for most cases of acute otitis media. Acute otitis media is not contagious, but the upper respiratory illnesses that can lead to it may be.

Otitis media with effusion is a build-up of fluid in the middle ear that can happen in two ways. When a child has a cold, the middle ear may produce fluid just as the nose does; however, the fluid does not run out as easily from the middle ear because of blockage of the eustachian tube. Or, when a child has recently had acute otitis media, fluid may remain in the middle ear even after the infection clears.

What are the signs and symptoms of otitis media?

Acute otitis media is an infection that can cause pain, fever, or an inflamed eardrum. It can occur in one or both ears. Symptoms in infants and toddlers include:

Tugging or scratching at the ear
Hearing problems
Crying, irritability
Fever
Vomiting
Ear drainage

Young children, adolescents, and adults have these symptoms:

Ear pain
Feeling of pressure
Hearing problems
Dizziness, loss of balance
Nausea, vomiting
Ear drainage
Fever

Otitis media with effusion is fluid in the middle ear. It can occur in one or both ears. Most children do not have fever or pain with middle ear fluid. The main symptom is difficulty hearing. Children may also have a runny nose, cough, and/or diarrhea.

How is otitis media diagnosed?

Otitis media is diagnosed based on one of two tests to confirm the presence of fluid behind the eardrum. In the test called pneumatic otoscopy, a health-care provider uses an otoscope to look for fluid, check the appearance of the eardrum, and see how well the eardrum can move. An eardrum with fluid behind it does not move as well as a normal eardrum. In a test called tympanography, a health-care provider uses a typanogram to see how well the eustachian tube is working and how well the eardrum can move.

A child has acute otitis media if there is:

Fluid behind the eardrum
Ear pain
Fever
Bulging red or yellow eardrum

A child has otitis media with effusion if there is:

Fluid behind the eardrum
Inability of the eardrum to move freely
No ear pain, no fever, no bulging red or yellow eardrum

Who is at risk for otitis media?

Anyone can get otitis media, but it occurs most often in children under 3 years of age. Ear infections are most common in young children because their eustachian tubes are small and easily blocked, and they have many colds. Some children seem to be more likely than others to get otitis media. Recent studies show that children who live with smokers, who are not breastfed, and who spend time in group childcare have more ear infections.

What complications can result from otitis media?

Many children have a brief, minor hearing loss during and right after an ear infection. Hearing loss occurs when the build-up of fluid in the middle ear impedes the ability of the eardrum and middle ear bones to move freely. Too much fluid in the ear can also put pressure on the eardrum and eventually tear it.

Although the hearing loss caused by otitis media is usually temporary, untreated infections can lead to permanent hearing damage. Persistent fluid in the middle ear and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development.

What is the treatment for otitis media?

Acute otitis media is treated with oral antibiotics. Amoxycillin is the first-line antibiotic for treatment of acute otitis media.

Children with otitis media with effusion usually do not need antibiotics. The fluid in the middle ear usually does not bother children, and it almost always goes away on its own after 3 to 6 weeks. If the fluid is still present after a few months and is causing hearing problems in both ears, antibiotics may help some children.

Unnecessary antibiotics can be harmful. After each course of antibiotics, children are more likely to carry resistant bacteria in their noses and throats. These resistant bacteria are not killed by the usual antibiotics. When children get infections with resistant bacteria, it may be more difficult to cure the infection. Children may need more expensive antibiotics, antibiotics by needle, or even antibiotics in the hospital. Since otitis media with effusion does not usually bother children, it is better to wait and give antibiotics only when they are needed.

How common is otitis media?

Otitis media is a common childhood ailment. Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more ear infections during their first three years.

How can otitis media be prevented?

To prevent the upper respiratory infections in children that can lead to otitis media:

1. Teach children to cover their mouths with a disposable tissue when they cough and to blow their noses with disposable tissues.

2. Only use a tissue once, and then throw it away.

3. Do not allow children to share toys that they put in their mouths.

4. Regularly wash and disinfect toys that children put in their mouths.

5. Make sure all children and adults use good handwashing practices.

6. Children who are prone to otitis media should avoid contact with sick playmates and avoid secondhand smoke.

7. Do not bottlefeed or breastfeed babies while they are lying down.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have questions about the disease described above, consult a health-care provider.